This is appendix 1 for the Information Statement on Food Allergy.
Non-IgE mediated food allergies
Non-IgE mediated food allergies include conditions such as Food protein-induced enterocolitis (FPIES), Eosinophilic Esophagitis (EoE) Food Protein-Induced Allergic Proctocolitis (FPIAP) and Non-EoE gastrointestinal Eosinophilic disorders (Non- EoE EGID). The mechanisms behind these are becoming more understood and whilst they all affect the gastro-intestinal system via an immune-mediated response against food, individual patterns of symptoms have been identified.
These include:
- Food Protein-Induced Enterocolitis (FPIES)
A delayed but acute reaction which may involve repeated vomiting and other gastro-intestinal symptoms 1-6 hours after a problem food (or infant formula) is consumed. See https://www.fpiesuk.org/what-is-fpies/
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Eosinophilic Esophagitis (EoE)
This is a chronic inflammatory condition of the oesophagus involving eosinophils (a type of white blood cell) which migrate to the oesophagus and then trigger an allergic reaction when a trigger food is eaten. Symptoms in both adults and children include difficulty swallowing, food impaction, vomiting and heartburn. Treatment may include avoidance of known trigger foods, the use of anti-allergy medication and possibly surgery to enlarge the oesophagus
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Food Protein-Induced Allergic Proctocolitis (FPIAP)
This is a delayed inflammatory condition seen in young babies from one to four weeks of age. Symptoms include blood in stools and diarrhoea. These babies are usually healthy and growing well. FPIAP mostly occurs in breastfed infants, but can also occur with formula. The main triggers are cow’s milk or soy. Treatment involves avoidance of these allergens and guidance to ensure adequate nutrition. See https://allergy.org.au/patients/food-other-adverse-reactions/proctocolitis-fpiap
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Non-EoE Gastrointestinal Eosinophilic Disorders (Non-EoE EGID)
Further information about these disorders is available here: https://gutscharity.org.uk/advice-and-information/conditions/eosinophilic-diseases/
Current and anticipated developments for Non-IgE-mediated food allergies
Further work is underway to improve the diagnosis and treatment of these conditions which cannot be diagnosed using skin or blood tests. Dietary avoidance, food challenges and/or endoscopies may be necessary for diagnosis. Treatment may involve avoidance of relevant foods, the use of steroids and proton pump inhibitors depending on the condition.
For further information, see Cianferoni A. Non-IgE Mediated Food Allergy. Curr Pediatr Rev. 2020;16(2):95-105. doi: 10.2174/1573396315666191031103714. PMID: 31670623, https://pubmed.ncbi.nlm.nih.gov/31670623/